Integumentary system.pdf

Integumentary system Raafet Hatem Structure of the Integument Layers of the skin: A. Epidermis B. Dermis C. Subcutaneous tissue Epidermal appendages: Hair Nails Glands: two types of skin glands: 1. Sweat Gland Eccrine sweat glands: are widely distributed and open dir...

Integumentary system Raafet Hatem Structure of the Integument Layers of the skin: A. Epidermis B. Dermis C. Subcutaneous tissue Epidermal appendages: Hair Nails Glands: two types of skin glands: 1. Sweat Gland Eccrine sweat glands: are widely distributed and open directly onto the skin surface and produce a dilute saline solution called sweat Apocrine sweat glands: open into hair follicle in axillary and genital areas and produce characteristic musky body odor 2. Sebaceous glands: Produce sebum (oily secretion) Skin Function: -Protective function -Identification color, fingertips -Sensory preceptor -Thermoregulation function -Stores water, fat and vitamin D -Promoting wound repair - Facilitate Joint movement - Excretory function History Questions Rational Items Current Are you experiencing any current skin Any of these symptoms symptom problems as rashes, lesions, dryness, may be related to a drainage swelling or increased pathological skin pigmentation? What aggravated the problem? What relieve it? The problem? What relieves it?  Describe a birth marks, tattoos? Have Know what is normal to any of them changed in color, size and detect the future shape? variation.A change the appearance or bleeding may indicate cancer Have you noticed any change in the Changes in ability to feel Changes in ability to feel pain pain sensation vascular neurological problems Have you had any hair loss? Describe? Patchy of hair loss may accompany infections stress Have you had any change in the Nail change may be condition of the nail? seen In systematic disorders Past Past History Describe any pervious Current problems may be History problems with skin ,hair including recurrent of a previous one line of management Have you had any allergic skin Various types of allergens can reactions of food ,medication plants precipitate a Varity of skin eruptions Family history Have any one of your family Some allergies may be had a recent rash or other skin identified from family history problems Life Style and Do you sunbath Sun exposure cause premature aging health of skin practice What is your daily health Regular habit provide routine of skin ,hair and nail information on hygiene and care? What product do you use lifestyle ,improper nail cutting ? How do you cut your nails techniques can lead to infection What kinds of food do you A balanced diet is necessary consume in a typical day for healthy skin, hair and nails  Skin Inspection 1-Color Evenly colored Pink ,Brown , black Pallor ( yellowish \white E.G. Sun exposed areas are darker arterial insufficiency ,decreased blood supply and anemia) (dark people yellowish brown /gray) -Cyanosis: white skin (dusky blue in perioral, nail bed) E.g. Central cyanosis: Cardiopulmonary problems Appears in the oral mucosa -Peripheral cyanosis local vasoconstriction -Jaundice (yellow to green mostly seen in sclera mucosa membranes thin skin -Rashes: as the reddish in the light skinned people or dark skinned people E.g. Butter fly rash across the bridge of the nose and cheeks characteristics of discoid lupus erythematous (DLS) -Erythematic (intense redness and warmth ) E.g. inflammation ,allergic reaction or trauma (dark people purplish) -Vitiligo (patchy de pigmentation) -Albinism (total loss of pigmentation) -Ecchymosis (Bruise): A large patch of capillary bleeding into tissues -Carotenemia (yellow orange) Hygiene Clean Dirty Smelly Odorless Integrity Intact :No redness areas Breakdown is initially noted as reddened area may progress to pressure ulcers Lesions Smooth without lesions Stretch Lesion may indicate local or marks (striae) systemic problems Primary lesions : arise from normal skin due to irritation or disease Healed scars Secondary lesions :areas from change in primary lesion Vascular lesions :radish bluish  lesions are seen with bleeding ,venous pressure aging liver disease or pregnancy -Freckles small, flat macules of brown melanin Pigment that occur on sun exposed skin -Nevi (mole) a proliferation on melanocytes, tan to brown color flat or raised Palpation Smooth and intact Firm and Rough ,dry and flaky is seen Texture use intact hypothyroidism psoriasis Velvet fingers tips (very soft and very smooth) as the hyperthyroidism Thickness Uniformly thin calluses, rough Very thin :E.g. Clients with arterial thickened over growth of insufficiency or those steroid epidermis due to constant therapy pressure Moisture Dry.Moderate amount of Increased moisture or diaphoresis perspiration In face hands (profuse sweating) E.g. anxiety fever axillae skin fold or hyperthyroidism Decreased moisture overly dry)as E.g. dehydration or hypothyroidism Clammy skin is typical in shock or hypotension Temperature Warm and equal bilaterally I-Hyperthermia ( hot) used the Hand and feet may be slightly a. Generalized may indicate a febrile dorsal cooler in a cool environment state hyperthyroidism or after heavy surface of exercise the hand b. Localized Hyperthermia with inflammation infection trauma or sun burn 2-Hypothermia (cold) a. Generalized accompanies central circulatory disturbances as in shock hypotension b. Localized occurs in peripheral arterial insufficiency and Raynaued's disease Mobility how easily the Moderately mobile, Decreased mobility when skin can be pinch or raised Normal turgor (smooth edema is present Poor turgor (skin's elasticity, and elastic) Return to turgor Wrinkled (return to how quickly the skin place and original shape in place in more than 30 return to its original less than 30 second second tent and stands by shape) itself) is seen in dehydration or extreme weight loss Edemas Skin is rebound and does Unilateral edema consider thumbs to press down on not remain indented a local or peripheral cause the skin feet or ankle when pressure is released Bilateral edema or edema that is generalized over the whole body considers a center problem as heart failure or kidney failure Scalp and Hair Observation Scalp is clean and dry Black Gray : from reduced melanin Color Africans have very dry scalp and production fragile hair Vary from pale blond Normal from the 3rd decade to totally black depending on the Dull dry hair may be seen with amount of melanin present hypothyroidism Distribution Coarse terminal hair covers scalp Generalization hair loss may ,eye browns and eye lashes ,pubic occur with infection ,nutrition area axillae deficiency, hormonal disorder, liver or thyroid disease, drug toxicity chemo or radiotherapy —Fine vellus hair covers the body Hirsutism ( facial hair on females) may occur with hormonal abnormalities or side effect of steroids During puberty ,distribution Absent of genital hair or with according to the gender abnormal configuration suggested endocrine abnormalities Alopecia diffused \ patchy loss of scalp hair Palpate Pliant\Smooth Brittle hair Texture Fine\ thick Excessive oiliness Lesions Clean free from lesion Poor hygiene may indicate the Seborrhea (Dandruff , loose white need for teaching or assistance of flakes) the activities of the daily living Excessive scaliness may indicate dermatitis Raised lesions may indicate infections or tumor growth -Pediculosis.Nits/ Lice which are white tiny ovals adherent to hair shaft and cause intense itching -Folliculitis: Multiple pustules with hair visible at the center with erythematous base -Tinea capitis: Rounded patchy hair loss on scalp with broke hairs pustules and scales on skin Inspection Grooming - Clean and manicured Dirty : broken or jagged with And cleanliness poor hygiene or client's hobby or occupation Color and marking Clear \pink Longitudinal Pale or cyanotic may indicate ridging is normal hypoxia or anemia -Yellow discoloration may be fungal infection -Splinter hemorrhage: May with trauma or endocarditis -Beau's lines: Transverse depression in the nail. It results from trauma, exposure to cold. Shape and Smooth and rounded Slightly Traumatizes \bitten counter curved or flat Convex curve -Paronychia: swollen, redness indicate local infection Base and A 160 angle between the nail Koilonychia: It is represent by base angle base and the skin transverse and longitudinal concavity of the nail resulting in a spoon — shaped nail.As in Iron deficiency -Early clubbing 180 degree angle with sponge sensation Late clubbing greater than 180 can occur from hypoxia Palpation Hard basically immobile firmly Thickened nails (toes nails) Texture and attached to the nail bed caused by decreased circulation consistency Onycholysis : detachment of nail plate of nail beds. Seen in infection or trauma Test capillary Pink tone returns immediately Cyanotic nail bed return of pink refill to blanched nail bed when tone in greater than 2 second pressure is released with respiratory or cardiovascular disease that cause hypoxia Type of Lesion Description Example Primary lesion: Lesion developed on previously unaltered skin A. circumscribed flat non palpable change in skin color Macule A flat circumscribed area of color Freckles brown melanin with no elevation of its surface pigment that occurs on sun 1mm to 1 cm exposed skin flat nevi Patch Larger than Macule Vitiligo B. PaIpabIe elevated solid masses Papule A. Circumscribed solid elevation of skin less than 1 cm Nodule A solid mass extending deeper into Pigmented nevi dermis and firmer than papule Tumor A solid mass larger than nodule Epitheliomas Wheal A relatively reddened flat localized Mosquito bites hives collection of  C.Crircumscribed superficial elevation of the skin formed by free fluid in a cavity within the skin layers Vesicle Circumscribed elevation ( up to 0.5 Herpes Chicken pox, cm) containing serous fluid or blood herpes zoster Elevated cavity containing free fluid, up to 1 cm. "blister" cyst An encapsulated fluid filled mass in Epidermoid cyst dermis or subcutaneous tissue Bulla A large serous fluid filled vesicle Second degree burns Pustula A vesicle or bulla filled with pus Acne vulgaris secondary lesion that changed over time or changed because of a factor such scratching or infection A-Loss of skin surface Erosion Loss of epidermis that does not Moist area after the rupture of extent deeper surface is moist but a vesicle does not bleed Ulcer A deeper loss of skin surface Stasis ulcer extending into the dermis or below may bleed and scar Fissure A linear crack in the skin A thletes; foot Material on the skin surface Scale Thickened epidermal cells that flake Dandruff Psoriasis off Compact ,desiccated flaked of skin Crust The dried residue of serum pus or Impetigo herps blood Other lesion Atrophy A decrease in the volume of Stria epidermis Scar A formation of connective tissue Keloid replacing destroyed  Vascular skin lesion Petechia Round red or purple macule Bleeding tendencies secondary to blood extra vasation Small 1-2 mm Ecchymosis Round or irregular macular lesion Blood extravasation trauma larger than petechia.Color changes black , yellow and green hues Hematoma A localized collection of Trauma blood creating an elevated Ecchymosis Spider Red arteriole lesion with a central Pregnancy Angioma body with radiating branches. It is ,liver disease usually noted on the face, neck, ,vitamin B deficiency arms, and trunk. It is rare below the waist. Compression of the center of the arteriole completely blanches the lesion Cherry Popular and round red or purple Normal age related alteration Angioma may be blanched with pressure Venous Bluish or red lesion with varying it is secondary superficial star shape (spider-like or linear) found dilation of venous vessels and on the legs and anterior chest. capillaries associated with does not blanch when pressure is increased venous pressure applied. states (varicosities and Examination of skin Lesion A- Inspect lesions for (use penlight or magnifying glass): I-Color 2-Elevation 3-Size ( in centimeters ) use a ruler to measure dimensions 4-Content:Solid mass or fluid exudates (note its' color or odor) Border regular or irregular  5-Location and distribution on body :generalized or localized to area of a specific irritant around jewelers, watchband, around eyes 6-Configuration 7-Note the type of skin lesion B) Palpate skin lesion -Wear gloves if you anticipate contact with blood , mucosa ,any body fluid of skin lesion - Test the palpability of lesion -Roll a nodule between the thumb and index finger to assess depth base or if it bleed when the scale comes off - Note the surrounding skin temperature -Red macules from dilated blood vessels will blanch momentarily ( positive result) -Red macules from extravagated blood (Petechiae) do not blanch (negative result) -Note: Blanching test also helps identify a macular rash in dark — skinned people - Coin or oval-shaped as in nummular eczema. - Lesions that remain separate and apart are common in many skin disorders. Males (nevi) are an example. - Lesions that are grouped or clustered such as herpes simplex. - Lesions arranged in lines are common in contact dermatitis due to poison ivy or herpes zoster. - Ring-shaped lesion may be ringworm - Lesions arranged in partial rings or arcs occur in syphilis. - Mesh-like pattern as in lichen planus. - Coalesced concentric circles such as urticarial.